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- Introduction
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- References (22)
- Cited by (7)
- Recommended articles (6)
Journal of Orthopaedics
Volume 12, Supplement 1,
October 2015
, Pages S1-S6
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Abstract
Aim
To evaluate outcomes following staged anterolateral plating of pilon fractures.
Methods
Over a 5 year period, patients with pilon fractures received four treatment regimens (staged anterolateral plating, staged medial plating, definitive external fixation, early total care). We defined five outcomes (reduction, soft tissue complications, infection, non-union, malunion) and assessed the outcome of fractures treated by these interventions.
Results
Staged anterolateral plating or staged medial plating achieved comparable reduction and soft tissue complications. Staged medial plating had higher infection rates, malunion and non-union rates.
Conclusions
Staged anterolateral plating is superior to staged medial plating in the management of pilon fractures.
Introduction
The distal 8–10cm of the tibia, including the articular surface, is called the tibial pilon. Pilon fractures usually occur in adults in their thirties or forties caused by a fall from height or a motor vehicle crash.1 Pilon injury is relatively rare and constitutes approximately 5–7% of all tibial fractures.1 However, over 30% of pilon fractures are a result of high-energy trauma. These fractures are often associated with severe soft tissue trauma and concomitant polytrauma, making treatment extremely difficult and management challenging for the treating surgeon. Post-operative complications such as wound break down and infection are common and post-traumatic arthritis also occurs in a large number of patients even with adequate joint restoration.2 Treatment of pilon fractures involves a delicate balance between obtaining a strong and stable construct with anatomic articular reduction, while giving careful attention to the delicate soft-tissue envelope. The two-stage procedure protocol viz. the use of the external fixator in the first stage and the internal fixator in the second stage has been applied to successfully treat pilon fractures for many years in different countries around the world.2 In general, fixation of the articular surface and tibial shaft is addressed through a variety of anterior incisions (anteromedial, anterior, or anterolateral) or posterior incisions. The classical approach is to use an anteromedial incision to fix the tibial plafond and a postero-lateral approach to fix fibular fractures and to address the posterior fragments. This type of approach mainly depends on the fracture pattern and surgeon preference. Recently, the anterolateral approach to the tibia has been popularized. Herscovici etal described this approach, called the Bohler incision and recommended this distal extensile approach for the management of foot and ankle injuries involving the anterior talar dome, talar neck, talonavicular joint, subtalar joint, calcaneo-cuboid joint, and the bases of the third and fourth metatarsals.3 This approach provides excellent visualization of the anterior end of the distal tibial, the distal tibio-fibular joint and the ankle joint helping the surgeon achieve excellent reduction of the articular surface. More importantly, the approach provides better soft tissue envelope to cover the fracture site and the hardware used for the fixation. The drawback of the approach is however limited access to the medial ankle joint making fixation of the fractures of the medial malleoli difficult.
Logical thinking dictates that combining these two methods (staging and using the anterolateral approach) should give us the best outcomes in the management of these difficult fractures. We hypothesized that staged anterolateral plating is superior to all other modes of fixation including medial plating.
Section snippets
Methods
We retrospectively collected data from patients who underwent treatment for pilon fractures between September 1, 2007 and September 20, 2012. Institutional review board approval was obtained prior to the start of the study. All patients aged 15–90 years who had been treated with staged anterolateral plating, staged medial plating, early total care, or definitive external fixation were considered for the study. Patients with other means of fixation (such as extreme nailing), with inadequate
Results
Both anterolateral plating technique and medial plating achieved comparable satisfactory reduction (Table 1). Satisfactory reduction was best achieved in the early total care cohort and worst in the definitive external fixation group (Table 1). Staged anterolateral plating and staged medial plating had comparable soft tissue complication rates. Both non-union and malunion rates were higher in the staged medial plating group compared to the anterolateral group. Staged medial plating also had
Discussion
The treatment of pilon fractures is difficult and marred by high complication rates. Harris etal4 observed post-traumatic arthritis in 39% of his cases at a mean follow up of 26 months after surgery. In a retrospective study, Pollak etal5 reported on of 80 patients who had sustained fractures of the tibial plafond. With an average follow up of 3.2 years, 35% of the patients had substantial ankle stiffness, 29% persistent swelling and 33% ongoing pain. Sixty-eight percent of patients reported
Conclusion
- 1.
Staged anterolateral plating technique is superior to other means of fixation in a comparable setting.
- 2.
Early total care when performed in carefully selected patients gives excellent results.
- 3.
Staged anterolateral plating is superior to staged medial plating in its ability to salvage superficial infections. This in turn is because of better soft tissue coverage in the anterolateral region of the ankle.
- 4.
The most important factor in determining outcome was whether the open fracture or a closed
Conflicts of interest
All authors have none to declare.
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A retrospective analysis of comminuted intra-articular fractures of the tibial plafond: open reduction and internal fixation versus external Ilizarov fixation
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Tibial pilon fractures: a review of incidence, diagnosis, treatment, and complications
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Foot Ankle Int
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Outcomes after treatment of high-energy tibial plafond fractures
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Early complications following the operative treatment of pilon fractures with and without diabestes
Foot Ankle Int
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Outcomes of ankle fractures in patients with uncomplicated versus complicated diabetes
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Complication rates following open reduction and internal fixation of ankle fractures
J Bone Joint Surg Am
(2009)
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Smoking cessation reduces postoperative complications: a systematic review and meta-analysis
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Plate osteosynthesis in bicondylar fractures of the tibial head
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Cited by (7)
Minimally Invasive Reduction and Fixation Techniques of Pilon Fractures Based on the Preoperative CT Findings
2022, Journal of Foot and Ankle Surgery
Citation Excerpt :
Patients identified as tobacco users were 3.5-5 times more likely to develop surgical site infections after ankle fracture surgery (41,42). Deivaraju et al (36) reported a higher infection rate among smokers when compared to nonsmokers (33.3% vs 15.3%). In our study, none of the 13 smokers (15.66%) developed wound complications, malunion/nonunion, or fair/poor results.
(Video) dr. Nikica Darabos - Stage Treatment of Pilon FractureTibial plafond fractures are often associated with significant articular cartilage and soft tissue damage. The presence of co-morbidities has been associated with an increased risk of surgical site complications. With improved in surgical techniques and implants, complication rates have declined; however, the overall prognosis often remains poor. The aims of this study were to evaluate the results of innovative minimally invasive reduction and fixation techniques in tibial plafond fractures based on a CT classification and to compare the difference between short and long-term outcomes. Based on preoperative CT findings, fractures were classified into varus, valgus, anterior, posterior, and neutral types. The minimally invasive reduction and fixation techniques depend on type of fracture, size and location of the intraarticular fragments, and degree of comminution of the extra-articular component. Ninety-one pilon fractures (90 patients) underwent minimally invasive reduction and fixation, of which 7 fractures (7.69%), required open reduction because of intraoperative failure to achieve anatomic reduction. Of the 84 fractures that underwent successful minimally invasive reduction and fixation reported, 35 fractures (41.7%) with excellent outcomes, 40 fractures (47.6%) with good outcomes, 6 fractures (7,1%) with fair outcomes, and 3 fractures (3.6%) had poor outcomes for the long-term American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score (follow-up ≥ 60 months). These results prove that minimally invasive treatment is an effective and durable treatment option for intra-articular pilon fractures. We encourage future clinical studies to further refine minimally invasive techniques for pilon fractures to improve outcomes.
Early clinical and radiographic outcomes of a mini-fragment, low profile plating system in tibial plafond fractures
2019, Injury
Citation Excerpt :
Multiple surgical techniques have been developed to address the challenges associated with tibial plafond fractures. These treatment regimens include definitive external fixation, immediate open reduction and internal fixation (ORIF), staged reconstruction, and arthrodesis [4]. Each treatment modality has shown favorable outcomes in the literature but can be associated with complications such as non-union, hardware failure, soft tissue issues, and infection [2,4–6].
The Smith and Nephew mini-EVOS plating system is a mini-fragment, low profile, variable-angled plating system designed to obtain anatomic reduction while also minimizing soft tissue handling. However, literature has been limited in reporting the clinical and surgical outcomes of these specific plates. The goal of our study is to evaluate the safety and efficacy of the Smith and Nephew mini-EVOS plate in pilon fracture management, where significant high energy forces can result in severe fracture patterns and soft tissue injury.
Patients 18–65 years of age who underwent plate fixation of their tibial plafond fractures (OTA/AO) using the Smith and Nephew mini-EVOS plating system at our urban university-based level-1 trauma center were included in this retrospective investigation. A total of 37 patients (37 fractures) from January 2015 to March 2018 were included in this study. Primary outcome measure was mechanical hardware failure. Secondary outcome measures included nonunion, malunion, medical and surgical complications.
The fractures were classified according to the OTA/AO classification as 43C1 (n = 15), 42C2 (n = 6), and 43C3 (n = 16). A mechanical failure was observed in three patients (8.1%). Six additional patients needed a re-operation of the surgical site including two nonunion repairs, one malunion repair, one symptomatic hardware removal, and two soft tissue debridements. The mean follow-up was 298.9 days (range: 96–936).
Early results of operative fixation of tibial plafond fractures using the Smith–Nephew mini-EVOS demonstrated low hardware failure and complication rates. This plating system is a safe and effective implant.
Level of evidence: Therapeutic Level IV.
Fractures of the tibial pilon treated by open reduction and internal fixation (locking compression plate-less invasive stabilising system): Complications and sequelae
2018, Injury
Citation Excerpt :
Penny et al. recently reported that anterolateral plates are superior in addressing the coronal primary fracture line across the apex of the tibial pilon and buttressing the zone of comminution, and also that in complex intra-articular tibial fractures the addition of a second plate is needed for appropriate stability [9]. Deivaraju et al. analysed the two-stage treatment, using a medial plate or an anterolateral plate during ORIF [21]. They encountered similar outcomes in terms of quality of reduction and soft-tissue complications; however, they found a higher prevalence of infection and nonunion with medial plates [21].
The aim of this study was to evaluate variables that could be related to complications and sequelae in fractures of the tibial pilon treated by open reduction and internal fixation (ORIF) with a locking compression plate-less invasive stabilising system (LCP-LISS).
A total of 137 fractures treated by ORIF in a 7-year period were analysed. The mean follow-up was 3.3 years. We analysed the following variables: age, sex, side, type of fracture, energy of the injury, use of provisional external fixation (EF), time until ORIF, stages of treatment (one or two), surgical approach, type of bone fixation, quality of reduction, use of bone graft, hardware removal, associated fractures (fibula and others), functional results (AOFAS scale), early complications (infection, skin necrosis) and late complications (nonunion, early post-traumatic ankle osteoarthritis [AOA]).
According to the AOFAS scale, 30.5% of the results were excellent, 46.7% good, 13.1% fair and 9.7% poor. The rate of infection was 8.7%, and the rate of skin necrosis requiring flap coverage was 15.2%. Furthermore, type 43C3 fractures of the AO classification had a higher rate of skin necrosis and flap coverage. The rate of nonunion was 16.3% (22 cases, 4 aseptic, 18 infected), and the use of a medial plate was related to a higher rate of nonunion than the use of a lateral plate. The rate of early post-traumatic AOA was 13.1%, and open fractures were related to a higher prevalence of nonunion and flap coverage. Both infection and a suboptimal anatomic reduction were related to a higher prevalence of fair and poor results. The anteromedial approach was associated with a higher prevalence of skin necrosis and early post-traumatic AOA than the anterolateral approach.
Optimal reduction and stable fixation is paramount to diminishing the rate of complications and sequelae after ORIF (LCP-LISS) of these fractures.
Analysis of the variables affecting outcome in fractures of the tibial pilon treated by open reduction and internal fixation
2017, Journal of Clinical Orthopaedics and Trauma
To assess variables that could be related to outcomes in fractures of the tibial pilon treated by open reduction and internal fixation (ORIF).
(Video) AO Trauma NA Webinar— Pilon Fractures: Fixation Strategies and TechniquesRetrospective.
University Hospital.
A total 92 fractures of the tibial pilon treated by ORIF in a 5-year period. The minimum follow-up was 1year (mean: 3.3 years; range: 1–5).
ORIF with LCP-LISS plate.
Age, sex, side, type of fracture, energy of the injury, provisional external fixation (EF), time until ORIF, stages of treatment (one or two), surgical approach, type of bone fixation, quality of reduction, bone graft, hardware removal, associated fractures (fibula and others), functional results (AOFAS scale), rates of infection, skin necrosis, flap coverage, non-union, and early posttraumatic ankle osteoarthritis (AOA).
According to AOFAS scale 30.5% of results were excellent, 46.7% good, 13.1% fair and 9.7% poor. Overall, the rate of infection was 13.04%, The rate of non-union was 10.86%. The rate of skin necrosis was 7.6% and the rate of flap coverage was 13.04%. The rate of early posttraumatic AOA was 13.04%. Type 43C3 fractures of the AO classification had a higher rate of skin necrosis and flap coverage. Open fractures were related to a higher prevalence of nonunion and flap coverage. The use of a bone graft was associated with a higher rate of nonunion and poor results. Infection was related to a higher prevalence of fair and poor results. EF was associated with a higher need for flap coverage. A suboptimal anatomic reduction was related to a higher rate of fair and poor results. The anteromedial approach was associated with a higher prevalence of skin necrosis and early posttraumatic AOA than the anterolateral approach. The use of an medial plate was related to a higher rate of nonunion than the use of a lateral plate.
The anteromedial approach was associated with a higher rate of skin necrosis and posttraumatic AOA than the anterolateral approach. Medial plating had a higher prevalence of nonunion than lateral plating.
IV (case series).
Early Reduction of the Posterior Column: A Surgical Technique in AO/OTA C3 Tibial Pilon Fractures
2023, Journal of Personalized Medicine
A systematic review and meta-analysis of functional outcomes and complications following external fixation or open reduction internal fixation for distal intra-articular tibial fractures: an update
2019, European Journal of Orthopaedic Surgery and Traumatology
Recommended articles (6)
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Coincident liposarcoma, carcinoid and gastrointestinal stromal tumor complicating type 1 neurofibromatosis: Case report and literature review
Journal of Orthopaedics, Volume 12, Supplement 1, 2015, pp. S111-S116
Neurofibromatosis type 1 (NF1) is associated with increased risk of multiple neoplasms. We present a case of a female patient with NF1 who presented with a rectal low-grade neuroendocrine (carcinoid) tumor. Computed tomography imaging found a well-differentiated liposarcoma and a well-circumscribed gastro-intestinal stromal tumor (GIST). Although GIST and carcinoid tumors are frequently found in NF1 patients, liposarcoma complicating NF1 is quite rare and this is the first reported case of well-differentiated liposarcoma in NF1. In summary, we report a case of coincident abdominal carcinoid tumor, GIST and well-differentiated liposarcoma, which illustrates the variability of neoplasms in NF1 patients.
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Braided tape suture provides superior bone pull-through strength than wire suture in greatertuberosity of the humerus
Journal of Orthopaedics, Volume 12, Supplement 1, 2015, pp. S14-S17
The purpose of this study is to compare the pull-through strength of transosseous braided tape suture with wire suture in proximal humeri bones (greater tuberosity).
A biomechanical study on eight cadaveric human specimens where two transosseous sutures were randomly applied on each specimen (anterior and posterior). Force/displacement curves were obtained for each specimen and the maximum pull-through load was noted.
There is a significant difference in maximal pull-through strength favoring braided tape suture over wire suture.
Transosseous braided tape suture provides almost twice the bone pull-through strength and is slightly correlated to volumetric bone mineral density.
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Intramedullary nailing versus minimally invasive plate osteosynthesis for distal extra-articular tibial fractures: a prospective randomized clinical trial
Journal of Orthopaedic Science, Volume 20, Issue 4, 2015, pp. 695-701
(Video) Tibial Pilon fractures from the HarborviewThe purpose of this randomized clinical trial is to compare intramedullary nailing (IMN) versus minimally invasive plate osteosynthesis (MIPO) for the treatment of extra-articular distal tibial shaft fractures.
Twenty-five consecutive patients with distal extra-articular tibial fractures which were located between 4 and 12cm from the tibial plafond (AO 42A1 and 43A1) were randomly assigned into IMN (n:10) or MIPO (n: 15) treatment groups. All patients were followed for at least 1 year. Foot function index, time to weight bearing, union time, duration of operation, length of incision, intra-operative blood loss, intra-operative fluoroscopy time, rotational and angular malalignment, rate of infection, secondary interventions and complications were compared between groups.
All patients completed the trial and were followed with a mean of 23.1±9.4 months (range 12–52). Foot function index, weight bearing time, union time, rate of malunion, rate of infection and rate of secondary interventions were all similar between groups (p=0.807, p=0.177, p=0.402, p=0.358, p=0.404, p=0.404, respectively). Intra-operative blood loss, length of surgical incision, radiation time and rotational malalignment were higher in the IMN group (p=0.012, p=0.019, p=0.004 and p=0.027, respectively).
Results of our study showed that both treatment methods have similar therapeutic efficacy regarding functional outcomes and can be used safely for extra-articular distal tibial shaft fractures, and none of the techniques had a major advantage over the other.
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Local infiltration anesthesia with steroids in total knee arthroplasty: A systematic review of randomized control trials
Journal of Orthopaedics, Volume 12, Supplement 1, 2015, pp. S44-S50
Local infiltration anesthesia (LIA) with anesthetics, steroids, NSAIDS, and epinephrine has been shown to be effective in reducing total knee arthroplasty (TKA) postoperative pain. This systematic review explores the functional outcomes of randomized control trials that have compared the use of LIA with and without steroids during TKA. Five studies with 412 patients met the inclusion criteria, 228 received local infiltration anesthesia with steroids (LIAS) and 184 received local infiltration anesthesia without steroids (LIAWS). The use of LIAS in management of postoperative TKA pain has been shown to decrease the length of hospital stay, time required to achieve straight leg raise, and pro-inflammatory signals in patients. Although there is no overwhelming data to suggest LIAS improves postoperative TKA pain, current literature does support its effectiveness in producing other favorable surgical outcomes.
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Pediatric lower limb Ilizarov lengthening with functional evaluation in adulthood: A report on underprivileged patients
Journal of Orthopaedics, Volume 12, Supplement 1, 2015, pp. S69-S74
Ilizarov lengthening, with the principles of Ilizarov, requires a collaboration and supervision of the physiotherapist, nurse, and psychologist, preferably in a group-therapy set-up. We report the mid- and long-term functional outcome of cases that had none of the above listed supporting elements. In addition, we tried to observe the effect of the disease category on the final outcome in the patient.
In this study, 35 children who had undergone Ilizarov lower limb lengthening were evaluated using the following methods: clinical, radiographic, and by four functional scoring systems, and parent/patient satisfaction questionnaires, after an average of 17.2 years (10–25 years).
In this study, 19 boys and 16 girls aged 5–16 years received 18 femoral and 20 tibial lengthening. An average of 6.2cm lengthening in the femur and 8.4 in the tibia was achieved, with a healing index of 26.5 days. The disease category did not significantly affect the healing index, but the complications, 0.5 per femoral and 0.7 per tibial segment, were more common among congenital, and least among post-traumatic discrepancies. A complete improvement in joint stiffness was observed by 6–12 months post-frame removal in 83% of the cases, following home therapy by parents alone.
The long-term results of Ilizarov lengthening for lower limb discrepancy in children, even without group-therapy or good supportive aids, can improve function and maintain patient satisfaction in two thirds of the cases, over an average period of 17 years.
IV.
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Clinical assessment after total hip arthroplasty using the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire
Journal of Orthopaedics, Volume 12, Supplement 1, 2015, pp. S31-S36
The aim of this study was to evaluate clinical outcomes using the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ).
100 consecutive patients at 6 months after total hip arthroplasty (THA) were evaluated.
The improvement rate for the pain subscale was significantly higher than that for the movement and mental subscales. Preoperative scores on the JHEQ movement and mental subscales were positively correlated to scores on the same subscales at 6 months after surgery.
We conclude that the most predictable aspect of THA is pain relief and preoperative hip-joint ROM and mental status influence 6-month postoperative outcomes.
(Video) Tibial Pilon Fracture - Everything You Need To Know - Dr. Nabil Ebraheim
Copyright © 2015 Prof. P K Surendran Memorial Education Foundation. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.
FAQs
How is pilon fracture treated? ›
Treatment. Many pilon fractures require surgery but, rarely, some stable fractures can be treated nonsurgically. Whether or not your doctor recommends surgery often depends on how out of place (displaced) the fractured pieces of bone are.
What is the best surgery for a pilon fracture? ›Open Reduction and Internal Fixation (ORIF)
Nowadays a staged protocol is the main choice for ORIF in the treatment of tibial pilon fractures. The main goals are the anatomical reconstruction of the articular surface and the restoration of the correct rotational alignment to achieve best functional results (54).
Some pilon fractures do not need surgical treatment. These are typically lower-energy injuries to the tibia and fibula at the ankle joint. The bones are broken but simply shifted out of place and these injuries tend to be less severe. These lower-energy pilon fractures can be treated with a leg cast.
Can you fully recover from a pilon fracture? ›Most pilon fractures require surgery. It usually takes three to six months after surgery for the fracture to heal completely. However, it often takes individuals a year or more to fully recover from the injury.
What is a pilon fracture also known as? ›Summary. A tibial plafond fracture (also known as a pilon fracture) is a fracture of the distal end of the tibia, most commonly associated with comminution, intra-articular extension, and significant soft tissue injury.
What is the treatment of fracture rehabilitation? ›- Oedema Management.
- Range of movement.
- Graded Progressive Exercises.
- Bed Mobility.
- Weight-bearing.
- Psychological Considerations.
- Patient and Caregiver Education.
Pilon fractures severely injure the cartilage in and around your ankle. This injury to the cartilage can cause arthritis, and arthritis may take years to develop. Patients may have stiffness, pain, swelling, and a hard time standing or walking for a long period.
How long does it take to walk after pilon fracture? ›Managing the pain is the first step. You most likely will begin moving your ankle anywhere from two to six weeks. You may be able to bear weight between two to three months. After four months, you may be walking after a pilon fracture with no assisted aid.
Why is it called a pilon fracture? ›First described by French radiologist Destot in 1911, pilon fractures are defined as injuries that involve the articular weight-bearing surface of the distal tibia. The term “pilon” is derived from the French language, meaning pestle, resembling a pharmacist's pestle when paralleled to the distal tibial metaphysis.
What type of fracture does not require surgery? ›Treatment for an Avulsion Fracture: Surgery is not necessary for most avulsion fractures; unless the detached bone fragment ends up at a significant distance from the bone. The medical provider will instruct you to rest and ice the injury and will recommend specific range of motion exercises.
What is non surgical treatment of foot fracture? ›
Immobilization: Casting the injured foot prevents the fractured bone from moving. Walking with the help of crutches is advisable to avoid bearing body weight until healing has occurred. The doctor may also suggest a brace or splint reduce motion of the ankle or foot.
How do you treat a fracture without surgery? ›- splints – to stop movement of the broken limb.
- braces – to support the bone.
- plaster cast – to provide support and immobilise the bone.
- traction – a less common option.
- surgically inserted metal rods or plates – to hold the bone pieces together.
- pain relief – to reduce pain.
- Femur. The femur is the only bone in the thigh and is the longest and strongest of all bones in the body. ...
- Spine. The spinal column protects the spinal cord. ...
- Skull. ...
- Wrist. ...
- Hip. ...
- Rib. ...
- Ankle. ...
- Pelvis.
Bone healing from 6 to 8 weeks post injury : Fracture becomes stable by this time The stage of fracture healing is reparative stage and bridging callus is seen clearly. After 8 weeks the remodelling phase begins and the fracture line is less distinct.
What are the surgical approach options for pilon fractures? ›Surgical treatment of the pilon fractures was in four steps: (a) restoration of the correct length and stabilization of the fibula; (b) reconstruction of the articular surface of the tibia; (c) insertion of cancellous autografts; and (d) stabilization of the medial aspect of the tibia with the use of a modified ...
What are the grades of pilon fractures? ›Grade 0 represents minimal tissue damage associated with simple fracture pattern. Grade 1 involves superficial abrasion or contusion. Grade 2 involves deep abrasion of skin or muscle contusion.
Is pilon fracture an ankle fracture? ›A pilon fracture is a type of break of the shinbone (tibia) that happens near the ankle. Most of the time, it includes breaks in both the tibia and fibula of the lower leg. The lower ends of these bones make up part of the ankle.
What are the 4 R's of fracture treatment? ›Resuscitate. Reduce (if displaced) – may be done by open reduction, closed manipulation or traction. Retain (to maintain position while healing occurs) – by internal fixation, external fixation or conservative methods. Rehabilitate.
What are the 5 stages of fracture healing? ›- Five Stages of Healing a Fracture.
- First stage: Hematoma formation.
- Second stage: Development of fibrocartilaginous callus.
- Third Stage: Development of bony calluses.
- Fourth Stage: Bone remodeling.
- Fifth Stage: Bone support and recovery.
- Phase 1 - Control Pain and Swelling.
- Phase 2 - Improve Range of Motion and/or Flexibility.
- Phase 3 - Improve Strength & Begin Proprioception/Balance Training.
- Phase 4 - Proprioception/Balance Training & Sport-Specific Training.
- Phase 5 - Gradual Return to Full Activity.
What is the long term trajectory of recovery following pilon fracture fixation? ›
Functional recovery following open reduction and internal fixation for pilon fractures was characterized by an initial decrease in function from baseline, followed by an increase between 6 months and 1 year, and then slower but continued increases from 1 year to 5 years.
What are the rarest bone fractures? ›Fractures of the upper arm, or humerus, are the least common. In recent years, upper arm fractures have accounted for about 20% of total upper limb fractures. Fractures of the wrist, hand, and fingers occur slightly more often than fractures of the forearm.
What is the prognosis for a pedal bone fracture? ›Recovery of Pedal Bone Fracture in Horses
With those fractures that do not include the joints, prognosis is good with early treatment. However, any fracture that includes the joint has a guarded prognosis due to the difficult healing process.
You'll be given advice by your doctor about how much you should move your leg and when you can put weight on it. It takes around 6 to 8 weeks for a minor fracture to heal. You'll probably need to use crutches or a wheelchair during this time, until it's possible to put weight on the leg again.
Will I walk again after pelvic fracture? ›After pelvic fracture surgery, patients are not allowed to bear weight or walk for six to 10 weeks. You will be taught by physical therapy to use crutches or a walker before leaving the hospital.
Does the fibula need to be fixed in complex pilon fractures? ›Conclusion: Fibula fixation in the treatment of tibial pilon fractures is not routinely necessary and does not result in decreased mechanical complications such as malunion, delayed union, nonunion and implant failure.
What is the most painful type of fracture? ›Comminuted fracture
This type of fracture requires a lot of force, which causes your bone to break into several pieces. A comminuted fracture typically brings very intense pain. Because the fracture is in several pieces, surgery is usually required to fix it.
The Femur is often put at the top of the most painful bones to break. Your Femur is the longest and strongest bone in your body, running from your hip to your knee. Given its importance, it's not surprising that breaking this bone is an incredibly painful experience, especially with the constant weight being put on it.
What are the worst types of fractures? ›If the bone breaks in such a way that bone fragments stick out through the skin, or a wound penetrates down to the broken bone, the fracture is called an open fracture. This type of fracture is particularly serious because once the skin is broken, infection in both the wound and the bone can occur.
Can a foot fracture heal without a boot? ›To heal, a broken bone must be immobilized so that its ends can knit back together. In most cases, this requires a cast. Minor foot fractures may only need a removable brace, boot or shoe with a stiff sole. A fractured toe is usually taped to a neighboring toe, with a piece of gauze between them.
What is the least painful foot fracture? ›
The least severe break is a hairline fracture.
Also called a stress fracture, a hairline fracture is a small crack that doesn't go through the bone. Stress fractures are common in athletes and others who engage in repetitive jumping and running.
Although minor fractures can heal on their own, more serious fractures will require surgery. If you've experienced a fracture in your foot and/or ankle, you'll need to be treated by an orthopaedic surgeon who has knowledge of the intricate workings of the bones, tendons, ligaments and muscles of the foot and ankle.
What not to do with a fracture? ›Move An Injured Person On Your Own
Whether it is a foot fracture or another broken bone in your body, it is never advisable to move a seriously injured body part. Moving it around may result in further damage, especially if other parts like the head and the spine have been injured in the accident, as well.
It is commonly believed that the only nutrients needed for healthy bones and, therefore, the only ones that can enhance the fracture healing process are vitamin D and calcium [58].
Can a fracture heal without immobilization? ›Since it takes weeks for bone to heal, the bone needs to be immobilized the entire time.
What's the slowest healing bone in the body? ›Scaphoid fractures are known to have unpredictable healing. This is due to the unique anatomy of the scaphoid itself.
Which type of bone takes the longest to heal? ›A fracture of the upper arm or humerus may heal uneventfully in several weeks, while a fracture in the forearm takes much longer. The femur, or thighbone, is the longest and strongest bone in the body and difficult to break without major trauma.
Do bones get stronger after fracture? ›Once your broken bone heals fully, it should be just as strong as the rest of your bones, so you won't be more or less likely to break it than another bone.
Does walking help a fracture heal? ›When we break a bone, oxygen and blood flow are both extremely important for helping the fracture heal. So when we exercise, our blood vessels enlarge, allowing more oxygen, nutrients and growth factors to flow to the fracture site.
What happens if you don t do physical therapy after a fracture? ›Now let's say you chose not to seek treatment. The injury, whether it's a fracture or sprain will eventually heal over time. The risk is that the injury heals improperly – that the body adapts to function around the pain instead of healing and returning to normal functioning.
Should you massage fractures? ›
Loosening the muscles and ligaments surrounding the site of the fracture can make a huge difference for the client. Increasing mobility– As a result of loosened ligaments and muscles, massaging the surrounding area of a fracture may be able to support with bringing back some much-needed mobility to the limb.
What is the other name for pilon fracture? ›A tibial plafond fracture (also known as a pilon fracture) is a fracture of the distal end of the tibia, most commonly associated with comminution, intra-articular extension, and significant soft tissue injury.
What is the surgical treatment for tibial plateau fracture? ›Surgical Treatment
The injury is usually fixed with metal plates and screws placed through a large incision. The type of fracture usually dictates what types of incisions and how many plates and screws are needed. Sometimes bone graft or types of bone cement are needed to support the joint surface.
In mature horses, fractures of the pedal bone can be treated with fragment removal, cast application, special shoeing or surgery – depending on the nature of the injury. These fractures respond best to a cast or a bar shoe with side clips. If there is significant displacement a surgical screw may be placed.
What is the surgical treatment for tibial stress fracture? ›Although most tibial stress fractures heal with nonoperative treatment, some may require surgical management. Surgical treatment options include intramedullary nailing, tension band or compression plating, and drilling with debridement and bone grafting.
How long before you can walk after tibial plateau surgery? ›If you had surgery for your tibial plateau fracture, you can put a little bit of weight on the leg after 6 weeks with the goal of walking normally by the 10th week. If you did not have surgery for your tibial plateau fracture, you can start walking safely with a knee brace in 4-6 weeks.
How long does it take for a tibial plateau fracture to heal without surgery? ›Luckily, in many cases, surgery is not required, but if there is displacement (if the bone has moved) then surgery may be necessary. Non-displaced tibial plateau fractures take up to 3-4 months without surgery to heal. When surgery is required these cases take around 4 months to heal.
Should I wear a knee brace after tibial plateau fracture? ›You HAVE TO use crutches and wear the hinged knee brace for 4 weeks. No weightbearing on the surgical leg. You may remove the brace only if your knee is completely straight and resting on the couch or bed.
Does compression help heal broken bones? ›The review of this literature establishes that compression in bone healing is not absolutely necessary.
How long does it take to recover from a tarsal bone fracture? ›You have sustained a fracture to one of your tarsal (foot) bones. This normally takes six weeks to heal but you may still have pain and swelling for up to six months after your injury.
How long does it take for a pedal foot fracture to heal? ›
Most fractures heal without any problems in about six weeks. However, it may take three to six months for your symptoms to settle completely – these can include pain or discomfort, stiffness, decreased strength, and swelling. The bones may take longer to heal if you suffer from diabetes or if you smoke.
Does a walking boot help a tibia stress fracture? ›Walking: You may walk on the foot as comfort allows but you may find it easier to walk on your heel in the early stages. The boot you have been given is for your comfort only and is not needed to aid fracture healing but will help to settle your symptoms and should be worn for walking for 6 weeks.
Can I still walk with a tibia stress fracture? ›Exercise: You can undertake non weight bearing exercise including swimming, upper body weight training only and grinder. You should not undertake any unnecessary walking, running, cycling, rowing, elliptical or anything with weight bearing attached to it.
Does it hurt to walk on a tibial stress fracture? ›Stress fractures
Symptoms: Pain while running, but over time, runners also will experience pain while walking and doing other activities. If the stress injury is significant, pain may persist at rest, too. Pain is often localized in one spot, rather than a spread out over a small area, as with shin splints.